Ania Jastreboff on the Transformation of Obesity Care

A Conversation with Dr. Ania Jastreboff About the SELECT Trial

It was an amazing moment. Hundreds upon hundreds people packed into huge convention hall to hear about the detailed outcomes of the first ever randomized controlled trial to show that treating obesity could prevent heart attacks, strokes, and cardiovascular deaths. The implications of the SELECT trial for obesity care will be enormous and we had the good fortune of an engaging conversation about this with Dr. Ania Jastreboff. Before that overwhelming crowd on Saturday, she was invited to present her thoughts.

What follows, in her words, are excerpts from that conversation. 

A Transformation

Obesity care is going through an incredible transformation. We are in a watershed moment brought on by the introduction of highly effective anti-obesity medications. Semaglutide was approved for chronic weight management or obesity in 2021 and just a few days ago, so was tirzepatide. Several more are in phase two and three clinical trials. There are many more in phase one.

Beyond Weight Loss

We already know that these medications lead to significant body weight reduction. The new medications in development are potentially even more powerful.

But when we think about treating obesity, we are thinking beyond weight reduction. We are treating obesity and in so doing, improving health outcomes. This is why the SELECT trial is so important.

As a part of this incredible transformation of obesity care, the SELECT trial has now shown, for the first time, that treating patients with cardiovascular disease and obesity, but without diabetes, results in a 20% reduction in major adverse cardiovascular events (MACE) – a composite endpoint of cardiovascular death, non-fatal MI, and non-fatal stroke.

Better Care in CVD and Obesity

Our current paradigm for cardiovascular risk reduction involves treating hypertension, hyperlipidemia, and type 2 diabetes. But imagine the future. Imagine that for cardiovascular risk reduction we can begin to target obesity. By treating obesity, we can also mitigate other diseases simultaneously.

This is the potential future the SELECT trial suggests.

A Turning Point

We should remember that the SELECT trial included mainly White, non-Hispanic men. So this limits the generalizability of these results for other populations.We need to do better. We need to recruit participants in our trials of the patients who are representative of the population and those who could benefit from these medications.

I believe this will be a turning point. It demonstrated a clear secondary benefit in cardiovascular disease outcomes for people with obesity who do not have diabetes. This therapeutic benefit was shown in a well-treated population, suggesting an incremental gain over the current standard of care.

So now is the time to treat obesity, improving health outcomes in people with heart disease.

We thank Dr. Jastreboff for an engaging conversation on the important milestone of the SELECT trial in obesity medicine and cardiovascular care.

Click here for the full publication of the SELECT trial results and here for a conversation with A. Michael Lincoff, the lead author on this study publication.

Ania Jastreboff Presenting on the Transformation of Obesity Care, photograph by Erica Spatz, MD, MHS, from the AHA Late Breaking Science Session, November 11, 2023 in Philadelphia

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November 16, 2023